Project Summary Since 1994, the rice paddy farmers in Northern Central Province (NCP) of Sri Lanka have been experiencing an unusual epidemic of Chronic Kidney Disease (CKD) that is not caused by traditionally known causes such as diabetes, hypertension or glomerular nephritis. As of today, CKDu has already killed 23,500 farmers and their family members. Another 69,000 have been diagnosed with the disease. Similar epidemics of CKDu among agricultural workers have been reported in Andra Pradesh in India, in Bangladesh and in Mexico and Central America. A number of research groups including the World Health Organization (WHO) have conducted research studies to determine the etiology of this unique type of CKDu in Sri Lanka. While there is the consensus that this is a multi-factorial disease, main factors include chronic exposure to Arsenic, Cadmium and nephrotoxic pesticides. Additional risk factors such as drinking water from shallow wells and the use of pesticides and contaminated triple phosphate fertilizer have been identified. However, how these factors interact in the specific hydrologic, geochemical and social environment al settings has not been systematically studied. We propose to take a multidisciplinary team of scientist from the US to Sri Lanka for a site field visit to NCP and conduct two workshops. The team members will be selected to represent the following areas of expertise: medicine and nephrology, public health, environmental sciences and engineering, surface and subsurface hydrology, soil science, geochemistry, behavioral sciences and environmental psychology, and geographic information systems. The workshops have two primary goals: (1) to gather information from Sri Lankan scientists who are active both in field and laboratory studies, and (2) to synthesize the gathered knowledge and identify key knowledge gaps through discussions and analysis. The final product of these workshops will be to develop a framework that integrates our understanding of the different factors that contribute to CKDu risk. A position paper, research agenda, and an action plan that could lead to a national CKDu policy in Sri Lanka will be developed. It is our expectation that this framework and plan will become the basis to develop strategies for both short and long-term interdisciplinary collaborative research efforts between not only Sri Lankan and US scientists, but will also from other countries where CKDu has become a health crisis that needs scientists to conduct research on the main risk factors leading to CKDu while delineating the similarities and the differences in the two geographical regions.